St. Luke's Health Memorial San Augustine
511 E. Hospital Street, San Augustine, TX · CommonSpirit Health · · NPI 1578547345
Published prices by procedure
Cash price is what you pay without insurance. The negotiated range spans the lowest to highest rate this hospital agreed with insurers.
| Procedure | Cash price | Gross charge | Negotiated range | Payers |
|---|---|---|---|---|
| Ghs layer closure 7.6 - 12.5 cm - 12034 CPT 12034 | $207.51 | $1,383.36 | $249.01 – $1,438.70 | 8 |
| Ghs layer closure 7.6 - 12.5 cm - 12044 CPT 12044 | $156.90 | $1,046.00 | $188.28 – $1,087.84 | 8 |
| Ghs layer closure 7.6 - 12.5 cm - 12054 CPT 12054 | $283.80 | $1,892.00 | $340.56 – $1,967.68 | 8 |
| Ghs layered repair 12.6 - 20.0 cm -12045 CPT 12045 | $199.95 | $1,333.00 | $239.94 – $1,386.32 | 8 |
| Ghs layered repair over 3.0 cm -12057 CPT 12057 | $541.05 | $3,607.00 | $649.26 – $3,751.28 | 8 |
| Ghs leukocyte alkaline phos (mayo) CPT 85540 | $80.55 | $537.00 | $7.22 – $483.30 | 21 |
| Ghs mbp CPT 83873 | $53.85 | $359.00 | $14.45 – $323.10 | 21 |
| Ghs moderate sedation < 5 yr, 30 min CPT 99151 | $462.90 | $3,086.00 | $55.53 – $3,209.44 | 15 |
| Ghs moderate sedation ea addtl 15 min CPT 99153 | $87.00 | $579.98 | $23.13 – $577.20 | 9 |
| Ghs musc test done w/n test comp CPT 95886 | $39.00 | $260.00 | $46.80 – $270.40 | 9 |
| Ghs musc tst done w/nerv tst lim CPT 95885 | $39.00 | $260.00 | $46.80 – $270.40 | 9 |
| Ghs musc tst done w/n tst non ext CPT 95887 | $25.95 | $173.00 | $31.14 – $179.92 | 9 |
| Ghs myocardial strain img spckl track CPT 93356 | $239.10 | $1,594.00 | $23.03 – $1,657.76 | 9 |
| Ghs nailbed repair/nail removal CPT 11760 | $301.57 | $2,010.42 | $361.88 – $2,090.84 | 8 |
| Ghs ng placement w fluoro guidance CPT 43752 | $175.34 | $1,168.92 | $84.24 – $1,052.03 | 8 |
| Ghs ot prosthetic training/15 min CPT 97761 | $29.85 | $199.00 | $33.12 – $191.36 | 9 |
| Ghs ot sensory integrative tech/15min CPT 97533 | $35.85 | $239.00 | $43.02 – $248.56 | 9 |
| Ghs pacing - transcutaneous CPT 92953 | $96.00 | $640.00 | $100.00 – $1,031.04 | 10 |
| Ghs paravert facet/nerve cerv ea add bil CPT 64492 | $105.75 | $705.00 | $100.00 – $1,135.76 | 10 |
| Ghs paravert facet/nerve lumb ea add bil CPT 64495 | $105.75 | $705.00 | $100.00 – $1,135.76 | 10 |
| Ghs peritonsillar abscess i andd CPT 42700 | $126.90 | $846.00 | $152.28 – $879.84 | 8 |
| Ghs phenylketonurid CPT 84030 | $17.40 | $116.00 | $4.62 – $104.40 | 21 |
| Ghs plngl fx pm cl CPT 26725 | $133.73 | $891.48 | $160.47 – $927.14 | 8 |
| Ghs prostatic acid phosphatase (mayo) CPT 84066 | $32.40 | $216.00 | $8.11 – $194.40 | 21 |
| Ghs protoporphyrins fract CPT 84202 | $39.30 | $262.00 | $12.05 – $235.80 | 21 |
| Ghs removal intranasal foreign body CPT 30300 | $64.13 | $427.50 | $76.95 – $444.60 | 13 |
| Ghs removal pharyngeal foreign body CPT 42809 | $166.35 | $1,109.00 | $199.62 – $1,153.36 | 13 |
| Ghs respiratory syncytical virus igg/m CPT 86756 | $62.40 | $416.00 | $13.35 – $85.50 | 21 |
| Ghs rsv eia (respir synctial vrs) CPT 87420 | $67.48 | $449.82 | $11.68 – $404.84 | 21 |
| Ghs sensitivity (per antimicro) CPT 87184 | $43.80 | $292.00 | $6.28 – $262.80 | 21 |
| Ghs simple repair 12.6 - 20.0 cm - 12005 CPT 12005 | $445.80 | $2,972.00 | $534.96 – $3,090.88 | 8 |
| Ghs simple repair 12.6 - 20.0 cm - 12016 CPT 12016 | $486.15 | $3,241.00 | $583.38 – $3,370.64 | 8 |
| Ghs simple repair 20.1 - 30.0 cm - 12006 CPT 12006 | $545.55 | $3,637.00 | $654.66 – $3,782.48 | 8 |
| Ghs simple repair 20.1 - 30.0 cm - 12017 CPT 12017 | $585.90 | $3,906.00 | $703.08 – $4,062.24 | 8 |
| Ghs simple repair 5.1 - 7.5 cm - 12014 CPT 12014 | $284.55 | $1,897.00 | $341.46 – $1,972.88 | 13 |
| Ghs simple repair 7.6 - 12.5 cm - 12004 CPT 12004 | $348.15 | $2,321.00 | $417.78 – $2,413.84 | 13 |
| Ghs simple repair 7.6 - 12.5 cm - 12015 CPT 12015 | $358.80 | $2,392.00 | $430.56 – $2,487.68 | 8 |
| Ghs simple repair over 30 cm - 12007 CPT 12007 | $679.20 | $4,528.00 | $815.04 – $4,709.12 | 8 |
| Ghs somatosensory testing lower extremit CPT 95926 | $89.85 | $599.00 | $100.00 – $622.96 | 9 |
| Ghs somatosensory testing upper & lower limbs CPT 95938 | $159.75 | $1,065.00 | $100.00 – $1,107.60 | 9 |
| Ghs speech-gen aug dev eval iii, st CPT 92608 | $38.55 | $257.00 | $46.26 – $267.28 | 9 |
| Ghs sphenopalatine ganglion block CPT 64505 | $160.05 | $1,067.00 | $192.06 – $1,109.68 | 8 |
| Ghs sp train/fitting sp device - kx CPT 92609 | $53.85 | $359.00 | $64.62 – $373.36 | 9 |
| Ghs superficial wnd dehiscence simp12020 CPT 12020 | $320.85 | $2,139.00 | $385.02 – $2,224.56 | 8 |
| Ghs tx distal phalangeal fx with manipulation CPT 26755 | $131.10 | $874.00 | $157.32 – $908.96 | 8 |
| Ghs urine, porphyrins quant CPT 84120 | $53.71 | $358.02 | $12.36 – $215.10 | 21 |
| Ghs vaginal delivery only CPT 59409 | $1,126.95 | $7,513.00 | $1,352.34 – $7,813.52 | 13 |
| Giardia lamblia antibody CPT 86674 | $32.31 | $215.34 | $12.36 – $193.81 | 21 |
| Gi inhouse confirmation CPT 87045 | $83.70 | $558.00 | $6.30 – $40.36 | 21 |
| Glove finger flexion right lg xl HCPCS L3912 | $68.83 | $458.85 | $68.83 – $412.97 | 10 |
| Glucagon 1 mg solution for injection HCPCS J1610 | $972.28 | $6,481.86 | $176.85 – $1,355.72 | 9 |
| Glucagon hcl 1 mg/ml solution for injection HCPCS J1611 | $876.92 | $5,846.09 | $552.26 – $3,550.23 | 9 |
| Glucagon plasma - sendout CPT 82943 | $60.75 | $405.00 | $12.00 – $364.50 | 21 |
| Glucose-6-phosphate dhydrogenase screen CPT 82960 | $19.98 | $133.20 | $5.08 – $45.00 | 21 |
| Glucose blood quantitative CPT 82947 | $25.95 | $173.00 | $1.30 – $16.46 | 21 |
| Glucose body fluid CPT 82945 | $38.63 | $257.50 | $3.30 – $185.40 | 21 |
| Glucose monitoring continual min 72hr pt CPT 95249 | $34.65 | $231.00 | $41.58 – $240.24 | 9 |
| Glucose tolerance test (gtt) 3 specimens CPT 82951 | $46.71 | $311.40 | $10.81 – $280.26 | 21 |
| Glucose tolerance test (gtt) >3 specimens each additional CPT 82952 | $15.26 | $101.70 | $3.29 – $91.53 | 21 |
| Glycopyrrolate 0.2 mg/ml injection solution HCPCS J1596 | $159.06 | $1,060.40 | $7.02 – $40.51 | 8 |
| Golimumab 12.5 mg/ml intravenous solution HCPCS J1602 | $1,734.50 | $11,563.33 | $12.54 – $10,407.00 | 9 |
| Gonadotropin follicle stimulating hormone (fsh) CPT 83001 | $78.30 | $522.00 | $7.20 – $80.77 | 21 |
| Gonadotropin luteinizing hormone (lh) CPT 83002 | $61.80 | $412.00 | $7.20 – $80.77 | 21 |
| Graft apligraf 3in 44sqcm-q4101-cost per sq cm HCPCS Q4101 | $22.92 | $152.80 | $21.40 – $137.52 | 10 |
| Graft impl ult thck 6x12cm -cost per sq cm HCPCS Q4116 | $17,536.05 | $116,907.00 | $21.49 – $138.11 | 10 |
| Graft nerve adv 3-4x70mm HCPCS C1762 | $21,477.18 | $143,181.15 | $59.22 – $355.32 | 10 |
| Graft patch felt ptfe 2x2 HCPCS C1768 | $17,112.38 | $114,082.50 | $286.35 – $1,718.10 | 10 |
| Graft puraplyam antimicrob 1.6-q4196-cost per sq cm HCPCS Q4196 | $1,181.41 | $7,876.05 | $22.34 – $159.54 | 10 |
| Graft sft tiss theraskin lg 5.1x7.6cm meshed 39 sq cm-q4121-cost per sq cm HCPCS Q4121 | $115.44 | $769.60 | $20.61 – $132.47 | 10 |
| Graft tiss strattice 10x10 frm 10x10cm firm -cost per sq cm HCPCS Q4130 | $3,691.64 | $24,610.88 | $3,445.53 – $22,149.80 | 9 |
| Graft xenmtrx sft rect 15x20cm HCPCS C1781 | $25,824.49 | $172,163.25 | $38.91 – $233.42 | 10 |
| Graft xenmtrx sft rect 19x28cm HCPCS C2625 | $1,683.36 | $11,222.40 | $441.00 – $2,646.00 | 10 |
| Great toe with reduction 28495 CPT 28495 | $118.58 | $790.50 | $142.29 – $822.12 | 8 |
| Growth hormone antibody CPT 86277 | $14.55 | $97.00 | $13.22 – $87.30 | 21 |
| G-tube reposition CPT 43761 | $180.45 | $1,203.00 | $216.54 – $1,251.12 | 7 |
| Guided cath fluid drainage 10030 CPT 10030 | $564.60 | $3,764.00 | $677.52 – $3,914.56 | 7 |
| Guide endoanchr sg-64 aaa 62cm HCPCS L8670 | $7,133.49 | $47,556.60 | $3,586.28 – $21,517.65 | 10 |
| Guide wire threaded 1.4x150mm HCPCS C1769 | $567.79 | $3,785.25 | $5.30 – $38.22 | 10 |
| Guide worley csg 9fx50cm std HCPCS C1892 | $986.55 | $6,577.00 | $30.24 – $174.72 | 8 |
| Guid loc target vol rad tx CPT 77387 | $146.55 | $977.00 | $175.86 – $1,016.08 | 9 |
| Gw stiffened micro access kit HCPCS C1894 | $1,231.02 | $8,206.80 | $7.38 – $94.50 | 10 |
| Haloperidol lactate 5 mg/ml injection solution HCPCS J1630 | $65.19 | $434.58 | $1.16 – $35.06 | 10 |
| Hand X-ray CPT 73130 | $256.20 | $1,708.00 | $109.09 – $1,776.32 | 15 |
| Haptoglobin quantitative CPT 83010 | $44.85 | $299.00 | $10.57 – $269.10 | 21 |
| Hbot, full body chamber, 30m HCPCS G0277 | $215.40 | $1,436.00 | $100.00 – $1,493.44 | 9 |
| Hcg qualitative CPT 84703 | $65.70 | $438.00 | $3.06 – $32.89 | 21 |
| Hcg quantitative CPT 84702 | $75.15 | $501.00 | $6.30 – $64.30 | 21 |
| Hc nm fusion spect CT unlisted CPT 78999 | $90.60 | $604.00 | $108.72 – $628.16 | 15 |
| Hc pet myocardial imaging metabolic eval single study CPT 78459 | $1,022.85 | $6,819.00 | $1,227.42 – $7,091.76 | 9 |
| Head CT scan (with and without contrast) CPT 70470 | $1,337.10 | $8,914.00 | $209.55 – $9,270.56 | 15 |
| Head CT scan (with contrast) CPT 70460 | $1,141.50 | $7,610.00 | $209.55 – $7,914.40 | 15 |
| Head CT scan (without contrast) CPT 70450 | $815.40 | $5,436.00 | $128.89 – $5,653.44 | 15 |
| Heart first pass add-on CPT 78496 | $138.00 | $920.00 | $37.94 – $956.80 | 9 |
| Helicobacter pylori antibody igm CPT 86677 | $52.35 | $349.00 | $14.15 – $314.10 | 21 |
| Hemodialysis one evaluation CPT 90935 | $505.05 | $3,367.00 | $100.00 – $3,501.68 | 8 |
| Hemoglobin fetal qualitative CPT 83033 | $6.58 | $43.86 | $6.72 – $39.48 | 21 |
| Hemoglobin methemoglobin quantitative CPT 83050 | $8.54 | $56.92 | $6.89 – $51.23 | 21 |
| Hemoglobin plasma CPT 83051 | $9.90 | $65.99 | $6.14 – $59.40 | 21 |
| Hemolysin acid CPT 85475 | $24.68 | $164.50 | $7.45 – $148.05 | 21 |
| Hemolysins and agglutinins incubated CPT 86941 | $38.25 | $255.00 | $10.17 – $229.50 | 21 |
A missing value means the hospital did not publish that price — it never means the price is zero. Real bills can add facility fees, supplies and professional fees; see our methodology.